Welcome to The Ohio Department of Aging

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Applicants applying to the Ohio Department of Aging to be certified as an agency provider for the PASSPORT Medicaid Waiver Program may request certification for the following services:

Adult Day Services: Enhanced

Independent Living Assistance: Telephone Support

Adult Day Services: Intensive

Independent Living Assistance: Travel Attendant

Alternative Meals

Minor Home Modification

Choices Home Care Attendant

Non-Emergency Medical Transportation

Chore Services

Non-Medical Transportation

Community Transition

Nutrition Consultation

Emergency Response System

Out-of-Home Respite

Enhanced Community Living

Personal Care Service

Home Delivered Meals

Pest Control

Home Medical Equipment/Supplies

Social Work/Counseling

Homemaker

Waiver Nursing

Independent Living Assistance: In-Person Activities

Documentation you will be required to submit:

Evidence of Services Provided. Documentation you have provided services to two adults for a minimum of three months for all services you are requesting certification. (Example: requesting certification as a personal care provider, please provide time sheets or task sheets that clearly show the duties completed in the consumer's home.)

Evidence of Payment for Services. Documentation you have received payment for services provided to two adults for a minimum of three months (Example: copy of invoice used to bill consumer for services and evidence you received payment for those services.) Payment for services can be from private pay, insurance, other Medicaid/Medicare programs, etc.

Registration with the Ohio Secretary of State. A copy of registration certificate with the Ohio Secretary of State.

Ohio Bureau of Workers’ Compensation Certificate. A copy of current certification in good standing with the Ohio Bureau of Workers’ Compensation.

Certificate of Commercial Liability Insurance. A copy of current policy of minimum of one million dollars in commercial liability insurance.

Employee Dishonesty or Property Damage Insurance. A copy of current policy for employee dishonesty or property damage to others. This requirement can be a warranty, surety or business services bond.

Table of Organization: A copy of a table of organization that includes the full name of each position and indicates lines of authority.

Completed and Signed W-9: This for will be automatically completed and available to download for signature during the online application process.

Ohio Health Plans Provider Enrollment Application/Time Limited Agreement for Organizations: This for will be automatically completed and available to download for signature during the online application process.

Proof of Residency: Evidence that applicant/CEO has been resident of Ohio for the last five consecutive years. Acceptable documentation includes: valid driver's license; notification of registration as an elector; a copy of an officially filed federal or state tax form identifying the applicant's permanent residence; any other documentation the responsible entity considers acceptable showing evidence the applicant has been a resident of Ohio for the past five years. If you currently live or have lived outside of Ohio anytime in the past five years, you are required to submit an FBI background check.

FBI record check (if lived outside of Ohio in past 5 years): If you currently live or have lived outside of Ohio anytime in the past five years, you are required to submit an FBI background check.

Non-Disclosure Statement: This form will be available to download for signature during the online application process.